Initial experience with remote magnetic navigation for left ventricular lead placement

Background - A novel magnetic navigation system allows remote steering of guidewires and catheters. This system may be used for left ventricular lead placement for cardiac resynchronization therapy (CRT). We sought to evaluate the feasibility and safety of magnetic guidewire navigation for CRT procedures. Methods - 123 consecutive patients underwent CRT implantation/revision procedures (including pacemaker upgrades in n = 22 and left ventricular lead placement after dislocation in n = 4 patients). Left ventricular lead placement in a coronary sinus side branch was performed either conventionally or using magnetic navigation. The magnetic navigation system (Niobe) consists of two permanent magnets creating a steerable magnetic field. Guidewires with integrated magnets align to the magnetic field and were used for over-the-wire implantation of pacemaker leads in the coronary sinus. Patients were assigned to conventional (n = 93) or magnetic (n = 30) navigation according to room availability. Venography of the coronary venous system was performed to select a target vessel for lead implantation. Results - Guidewire access to the target vessel was achieved in 100% using magnetic navigation compared to 87% with the conventional approach (P < 0.05). Implantation success rates, total procedure and fluoroscopy times did not differ significantly between groups. No periprocedural death and no intraoperative device dysfunction occurred in either group. The magnetic guidewire ruptured in one patient. Conclusion - Left ventricular lead placement using magnetic guidewire navigation to engage the desired coronary sinus side branch can be successfully performed for CRT.